Registed Nurses' Association of Ontario

Educational strategies to improve content and delivery of education by pediatric oncology nurses to families of pediatric patients that are newly diagnosed with cancer

Angela Filice, BA, BScN, RN, CPHON
McMaster Children’s Hospital

A diagnosis of cancer is emotionally distressing news to process for a newly diagnosed pediatric oncology patient and their family. There is an enormous amount of information that these families require to learn about their child’s diagnosis, side effects and treatment. In order for parents to properly care for their child and manage potential emergency situations at home, nurses need to effectively educate families about their child’s condition and treatment. On McMaster Children’s Hospital’s Pediatric Oncology Unit, 40% of nurses have less than five years’ experience. In a survey of the nurses, 93% of nurses expressed the need for formal education in providing effective education. The nurses lack a guide on what oncological topics are essential for newly diagnosed patients prior to their first discharge, and are not formally trained in methods of providing education. The skill development stream that I selected to focus on for my Advanced Clinical Practice Fellowship (ACPF) was that of leadership in education. My goal was to develop a workshop for nurses which will provide educational tools focused on improving the bedside nurse’s content and delivery of information and ability to facilitate client-centered learning, when teaching newly diagnosed pediatric oncology patients and families.

I began this fellowship with a review of the literature as outlined by the Children’s Oncology Group, as presented at the COG Symposium on Patient and Family Education. The essential content as recommended by the COG and APHON’s recommended family education checklist were compiled into a list and reviewed with my mentors. This was presented to the subcommittee of our ward’s Quality Council, the Patient/Family Education Working Group. Cochairing the working group enhanced my facilitative and organizational skills in preparation for the nursing workshop. Consensus was gained regarding assigning the most responsible team member as content expert and appropriate timing of teaching for each topic. The list of content items specific to nursing was tabulated into a needs assessment and surveyed nurses on their comfort level on each teaching topic, as well as comfort level on education methods. I reached out to other pediatric oncology centres to appreciate what is currently being done regarding nursing discharge teaching tools. The need for a discharge checklist was recognized and developed according to the essential topics. I was subsequently chosen to present as an expert panelist at the COG annual meeting focusing on critiquing and identifying essential elements required for a standardized discharge checklist, based on the recommendations developed by COG. I was invited to continue to participate in the development process of a published manuscript which will be used across COG institutions. Being involved in this process was simultaneously intimidating and stimulating; It allowed me to enrich my communication and public speaking skills and expand my network of professionals also aiming to improve patient and family education.

Learning about the importance of utilizing a variety of adjunct educational modalities in order to target the various learning needs of the families prompted me to search for options we can use on the ward. The introduction of two ward iPads will provide an interactive options for interactive apps which will be instrumental with the visual learners. It will also house an electronic version of the COG handbook for quick reference. Additional implementation changes included encouraging nurses to use the handouts as reference during educational moments instead of passively handing them to families, which has been shown to increase memory and compliance. Presenting the COG family handbook immediately post disclosure of diagnosis, versus close to discharge was also deemed an essential step that will become the new standard of practice on our ward. Additionally, I am finalizing a nursing resource binder with content based on the COG handbook outlining essential points from each mandatory teaching topic. This resource acts as a guide for nurses and ensures the information we provide our families is consistent.

The ensuing step in this process was to examined the literature and develop my knowledge and understanding of health literacy and clear communication. The RNAO’s clinical best practice guidelines for facilitating client centered learning is the core foundation of my fellowship. In preparation for developing the nursing workshop, I met with the Patient Education Specialist, one of my mentors. I was fortunate to assist with the development of two patient education handouts specific to our ward. The process of applying plain language and ensuring that written materials are accurate, accessible, and actionable was vital to my learning. Becoming familiar with this and understanding the rationale for how material is written has enabled me to apply this into my clinical practice and translate it into the nursing workshop. Nine nurses attended the four-hour long pilot nursing workshop where I reviewed the applied the L.E.A.R.N.S Model and RNAO best practice guidelines. Nurses completed communication self-assessments preworkshop. I applied principles of adult learning in the development of the session, whereby nurses had opportunities to work together to change words into plain language and engage in role play using the teach-back method.
Feedback from the nurses who attended the pilot education session was extremely positive. Nurses expressed value in learning the teach-back method and having teaching resources and materials available. In order to assess the workshop’s effectiveness on families and caregivers, I produced a patient satisfaction survey to assess newly diagnosed families pre-workshop. These were given to several newly diagnosed families on their first visit to clinic post initial discharge from the ward. Families agreed that the nurses consistently offered clear instructions on who and when to call for problems while at home and encouraged them to ask questions. However, responses from families also indicated that teach-back methods were not practiced by staff, and handouts and visual material rarely utilized. Once all of our nurses have attended the workshop and our new teaching guidelines implemented on the ward, I plan to deliver a post survey to families to assess the effectiveness and improvements in our new teaching methods.

Anticipated outcomes from the implementation of this project include an increase in the nurses’ satisfaction and confidence in education delivery to families. Patient and families’ satisfaction and trust in their healthcare team will also rise. Families will achieve an improved sense of autonomy and confidence in their ability to care for their child, increase adherence to the treatment plan, timely discharges, and decrease readmission rates due to error or confusion (Marcum, 2002).

This experience has enriched my expertise and added the skills required to implement and sustain a nursing education program. I gained valuable knowledge in health literacy and clear communication and how to put it into practice. This ACPF has elevated my leadership skills, enhanced my communication abilities, enabled me to become a better leader and mentor for my colleagues and a better nurse to my patients and families. Not only was I given a platform to enrich the skills and knowledge of my colleagues, but it propelled me to become actively involved at a larger scale by continuing to work ongoing with the COG on creating a standardized patient checklist. I am truly grateful to the RNAO for this memorable and invaluable learning experience.